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Transforming Women’s Health With Dorothee Goldman and Missy Lavender · StartUp Health NOW Podcast

• 0:00
  [ on-hold music] I asked in the audience how many people know about endometriosis, and maybe five out of 200 raised their hands. Today, it's in the news.
• 0:17
  People are talking about it. [intro music] Welcome to StartUp Health NOW, the podcast where we celebrate the entrepreneurs and innovators reimagining the future of health. I'm Logan Plaster.
• 0:30
  For this episode, I'm in the virtual recording studio with my colleague India Edwards to talk about women's health and the entrepreneurs innovating within this sector.
• 0:39
  This is part of our Health Moonshot programming series where we focus on one health moonshot each month for a year. India, thanks for joining me. Absolutely, Logan. I'm so excited to be here.
• 0:50
  So there's this study in the British Medical Journal from a couple years ago that looked at 72,000 medical research articles. They were looking at how often specific women's health issues got mentioned.
• 1:02
  Their conclusion confirmed something that I think you and I know, and we've talked about at StartUp Health for a long time, that women's health is often underrepresented and often undervalued in medicine.
• 1:13
  They did note a dramatic uptick in articles about women's health after 2005, but they attributed that to the appointment of the BMJ's first female editor-in-chief.
• 1:23
  So for much of the last century, most clinical trial participants were men. Most physicians were men. Most researchers were men.
• 1:31
  While that's changing rapidly, uh, these days, old habits and thought patterns are hard to rewire. Women's health issues can still seem to play second fiddle.
• 1:41
  Here's Dorothy Goldman, founder of Oratel Diagnostics, describing the problem. I think one of the main issues is that women have problem getting access to healthcare for their specific needs.
• 1:54
  Um, many times the formulas or the criteria are based on data that's not involving women, and so they don't fit the picture. And so the doctors don't know to do, what to do about their pain.
• 2:09
  For this episode, we wanted to dial up two female entrepreneurs, including Dorothy, who we just heard from, who are working to change the health paradigm in areas really neglected in the past.
• 2:20
  You know, when people think about women's health, they often think it's just about having babies. But there's a lot more to women's health than pregnancy and motherhood. So let's get into the interview with Dorothy.
• 2:29
  What is she building? Dorothy is a fascinating character and smarter than I'll ever be. She's come up with the first way to diagnose endometriosis using saliva. I'll let her introduce herself.
• 2:42
  I'm Dorothy Goldman, and I'm the CEO of Oratel Diagnostics. Oratel Diagnostics recently partnered or does a joint venture with Diagnostrix.
• 2:53
  We are now a joint company th- that has one location in Norway and the other in New York, and we work together to develop the first saliva-based diagnostic for endometriosis.
• 3:07
  One of the things that's cool about Dorothy is that she made her initial discoveries for her current company basically by accident.
• 3:13
  I mean, if you can call it an accident when you're just a smart person who's constantly curious and doing experiments. Somehow, a simple cooking class led to a discovery about fertility, and then...
• 3:26
  Well, I'll let her explain it. I wasn't s- going out to discover endometriosis.
• 3:30
  What happened was I was actually teaching a class to kids on cooking and chemistry, and we were using locally made li- litmus papers made from flower pigments.
• 3:39
  And we were just testing our saliva before and after eating a cookie, and we wanted to see what the difference was.
• 3:45
  And I had two classes, one in the morning and one in the afternoon, and they gave different results that depended on the time of day. So I thought, "Well, what's going on here?
• 3:53
  There might be some body rhythm that's changing." And I started mapping it and discovered I could measure my own fertility, and my neighbors started using it.
• 4:02
  And in our neighborhood, there were women, actually seven of them, that used it to conceive and have babies.
• 4:07
  And so the news got around, and there were other women in the neighborhood who were having difficulty, and they came to me, and I thought, well, they responded very differently.
• 4:17
  And I thought, "Well, my test isn't very good." But they all had endometriosis, and I didn't know what this was.
• 4:23
  It turned out there was an article in the newspaper just at that time about estrogen in the environment, and it mentioned endometriosis.
• 4:32
  So I called up the editor of the newspaper, and he introduced me to the Endometriosis Association, and that's how I got started with endometriosis.
• 4:41
  That all happened way back in the mid-'90s, but it launched Dorothy on a decades-long journey to help women with endometriosis get diagnosed faster and then get the care they needed.
• 4:52
  She discovered that this isn't some fringe problem like she thought at first or was told at first, but a serious chronic condition experienced by millions and going misunderstood and underdiagnosed.
• 5:04
  There are seven million women that are known to have endometriosis, but actually it's 10% of the population. So there's sizable number that never get diagnosed for s- several reasons.
• 5:16
  The technology for diagnosing endometriosis has not been well developed. It's limited particularly to imaging and surgery, and the imaging has turned out to be very unspecific.
• 5:29
  And so many women go to clinics with chronic pain, and they never get diagnosed. And they go away with no treatment, no plan, uh, nothing more than some pain pills. This is very ca- costly for the health system.
• 5:42
  It actually adds up to about $24 billion a year, and it's unrecognized.
• 5:47
  When I first started with endometriosis and I gave my first pitch deck, I asked in the audience how many people know about endometriosis, and maybe five out of 200 raised their hands. Today, it's in the news.
• 6:02
  People are talking about it.There's been a lot of public advocacy for endometriosis, so the atmosphere has changed considerably within the last 15 years.
• 6:14
  It's taken time, and change has probably been a lot slower than Dorothy would have liked, but Ortel is finally changing clinical behavior around endometriosis.
• 6:22
  We're just completing a study at Brigham and Women's on 200 women, and things are looking quite successful. And I've got a team there.
• 6:31
  We wanna work together and work with some other people in this world and make a big change for everybody. When I dialed up Dorothy, it wasn't just about getting the Ortel diagnostic story.
• 6:42
  It was to understand her journey in women's health and her perspective as a female founder. So I asked her how she'd seen things change over the last 30 years, and this is what she had to say.
• 6:53
  I've seen it change slowly, I would say. I still think that a lot of women go unrecognized for their pain.
• 7:02
  I think that some doctors have opened up and become more receptive and understanding, and I think that has changed the climate, but I think that's a minority. Mm.
• 7:13
  I think the vast majority still, there is a big gap in understanding what is endometriosis and how to care for it and what to do about it.
• 7:24
  How much of the problem is endometriosis specific, and how much of it is women's pain being underestimated or glossed over, uh, as it has, you know, in the past culturally? Well, I can't answer that exactly.
• 7:39
  I think one would have to go to sources like emergency clinics, um, and, um, clinics that focus on women's health, where you'd get more information on that.
• 7:52
  But from my, um, limited exposure in talking to people, the common piece of information is that no one understands their pain.
• 8:03
  [upbeat music] So what you've got is this micro issue of endometriosis, which Dorothy and her Ortel team are addressing through their novel point of care test.
• 8:19
  But then there's this macro issue, understanding women's pain, acknowledging their pain, naming the pain, not asking them to bear it for years and years without treatment or understanding. That's a health moonshot issue.
• 8:32
  I mean, more of a dignity issue, you know? Absolutely. And as I've recently become aware, it's also a cost issue, one that's costing billions of dollars a year, which I couldn't believe it.
• 8:43
  So that leads us nicely into our next bit, which is your interview with Missy Lavender, the CEO and founder of Ronalys. Yes.
• 8:51
  So I had an amazing conversation with Missy Lavender, uh, like you just mentioned, the CEO of Ronalys, which is a company that's also creating platforms and cool technology to improve experiences and outcomes for those living with pelvic health conditions.
• 9:05
  I'm gonna let her give you a flyover of what she's currently building. So our c- our commercial platform, the first one is, is going to be an FDA approved software as a medical device.
• 9:15
  CC, her name is CC, we've named her. What she does, if you think of, like, coach and connect.
• 9:20
  So she gathers data from you using validated instruments, our proprietary bladder diary, and then she starts you on a, a journey to understand kind of what we, what, what kind of the gold standard first line of care is called behavioral therapy.
• 9:35
  It's confusing because we all think behavioral therapy, but it's basically behavioral and lifestyle management, bladder training, fluid management, pelvic floor exercises, other exercises, breathing, all the things you would learn in, if you were working with a pelvic floor physical therapist.
• 9:50
  So we try to mimic that in a conversational platform. So it's going to be very engaging, ve- like you're chatting with your best girlfriend who's a nurse practitioner.
• 9:59
  And assuming that goes as well as we think it is, then we'll d- be doing a much bigger pivotal trial, it's called, beginning January of next year. Right.
• 10:07
  Now, in the meantime, we have kind of a skinny version we call our CC Light. That one we developed for a pharma client, um, and then expanded it. It's a five-day experience.
• 10:17
  It's, it's all assigned female at birth people right now, um, to give them kind of an orientation around their pelvic health, around their bladder health, and a few nuggets that they can do, like, right away.
• 10:27
  So maybe they don't know if they're a patient yet. Maybe when we market this, we'll market to doctors from primary care up, you know, as a way to potentially bridge to a specialist.
• 10:37
  Or when they make a specialist call, sometimes you have to wait four to six weeks to see somebody. So this kind of brings them in, you know, hot, ready to go,
• 10:45
  and can hopefully save the specialist some time, you know, diagramming their pelvis and talking about their bladder and what is overactive bladder and how do I know if I have it and all that stuff.
• 10:54
  So one thing I read when I was prepping for my interview with Missy was that one out of three women experience pelvic health issues and cost something like $100 billion a year, which is absurd in my opinion.
• 11:06
  And one thing she mentioned was that as of today, $100 billion is extremely conservative because research has indicated that just six years ago, pelvic health issues cost about $67 billion. I'll let her explain it.
• 11:20
  Ironically, I'm, I'm in a large consortium with NIH to prevent lower urinary tract symptoms or bladder issues.
• 11:26
  And when I walked into the first meeting six years ago, the published data we were all using was like $30 billion.
• 11:32
  And yet there was this one study, they, they, they asked us to read like, you know, 39 papers before we came, and one of them was a guy who deconstructed in the-- in like 2010 all the costs of just overactive bladder, and he came up with the number of 67 billion.
• 11:47
  Oh, wow. And I know when I walked in I'm like, "Okay, whoa, why are we talking 30 when at least-" Right... one condition-- And, and then if you look at fibroids, it's crazy. It's like, you know, 15 to $80 billion.
• 11:58
  So I just kind of added the conservative amounts for stress incontinence, urge incontinence, fibroids, abnormal uterine bleeding, you know, which is all menorrhagia and all that stuff.
• 12:07
  And 100 billion is very conservative and highlyHighly preventable, I think. So can we prevent it all? No. But can we get on all of these conditions earlier? Yes.
• 12:17
  You know, I was j- I just got off the phone with an investor who's gonna personally invest, which is exciting, and she's French. And she's like, "With... Don't, you don't even have to sell me.
• 12:25
  Like, we know in France if you have a baby, it's mandated that you get six weeks of pelvic floor physical therapy."
• 12:30
  'Cause they know, they're smart enough to know, if they don't, it just shows up in the back end- Right... you know, in 15, 20 years. It's much more expensive.
• 12:38
  So I would never tell you this is a prevention tool, but I am gonna tell you that we're gonna drive those costs down. And most importantly, only about 31% of urology patients even come back for a second visit.
• 12:51
  And so if they're not coming back, they're not getting better. Right. And if they don't get better, right, then not only do their symptoms get worse, but they stop moving.
• 12:58
  It's the number one thing women report to us, like, "I don't do my, I don't run anymore. I don't do my kickboxing class. Maybe I'm in the swimming pool. Maybe I'm pushing my partner away, but I'm not having sex.
• 13:07
  I'm just, I'm not getting on airplanes, so I'm isolated."
• 13:10
  Depression, anxiety, obesity, hypertension, heart disease, diabetes, all the things that we care about could potentially, in my humble opinion, be dramatically improved if we could just get women just faster care, and if we could then keep them connected to their provider.
• 13:26
  That's- So that's a big driver for us. Logan, isn't that crazy? It's nuts, but it is in line with what we were just talking about, uh, concerning the under-representation of women's health in the literature. Exactly.
• 13:39
  So not only are pelvic health concerns affecting millions of women around the world daily, but it's costing billions of dollars a year because it's just not being talked enough.
• 13:47
  It's not a, quote, unquote, "primary health concern", and it's just kind of thrown under the rug, in my opinion. Which, to shift gears, is exactly what we're trying to improve.
• 13:56
  We've got an entire Health moonshot dedicated to improving women's health.
• 14:00
  So I asked Missy if she could just pinpoint some of these reoccurring challenges she sees in the women's health space, and her thoughts on women's healthcare in general.
• 14:08
  Women's health has always been one of those crazy, uh, spaces that ebbs and flows. No and all puns intended.
• 14:14
  So when I started the foundation that was the foundation for Renalis, it was actually called the Women's Health Foundation years ago, everybody was just getting out of women's health.
• 14:23
  I mean, if you were talking menopause, God forbid, women's health, it was like, poof, rose. You know, all these major centers were closing them down.
• 14:30
  And so shockingly, here we are, you know, almost 20 years later realizing the importance of dealing with the person that makes, A, the most healthier decisions, we all know that, but actually spends the most dollars in healthcare on themselves.
• 14:44
  Right. You know, we are expensive. You know, we have life events. If we live long enough, we all get to menopause, and sometimes we have babies, and those are really expensive kind of tipping points.
• 14:53
  And you know, menarche, like just throw that in the beginning. And so people have been slow...
• 14:59
  You know, it's kind of like there's a herd mentality in every single industry, and I'm happy that the herd is finally recognizing that, you know, women/people with, you know, assigned female at birth are important.
• 15:11
  But I think that it, it, it's a fraction, you know? It's kind of like we know that only 3% of the VC money last year and every year goes to female founders.
• 15:19
  Well, when you look at FemTech, you know it's gonna be a trillion dollar market- Yeah... you know, in, in another very few years, like 2030. So it's, it's happening, but it's, you know, it's happening very slowly.
• 15:31
  And part of it is you have to go in front of a bunch of men and explain why fibroids or, you know, bladder issues and, you know, are, are a big deal.
• 15:37
  So I always say, "If you're uncomfortable with leaking, bleeding, and chronic pain, you're not alone." Right. "It's why people cope so long and wait so long.
• 15:44
  But, you know, don't get me wrong, except for the bleeding part, you all have it, too. Like, everybody can have chronic pelvic pain. Everybody can have an out of control bladder."
• 15:54
  And then they start going, "Oh, yeah, yeah. I'm up all the time. All my buddies- [laughs]... you know, they have to leave the golf course at every round, you know?"
• 15:59
  I'm like, "Yeah, well, it's a little different with you guys, and- Mm-hmm... and if you're leaking, you're in your doctor's office within 12 months with your partner. We stuff it." You know, I, I loved her entire answer.
• 16:11
  Although I only got a small amount of time to speak with her, I could tell she's gonna say what needs to be said and she's gonna do what needs to be done, and that's exactly the case in the women's health space.
• 16:21
  I think that's a good segue into my favorite part of this interview, which is when she chats about being a woman founder in the women's health space.
• 16:28
  You know, StartUp Health doesn't have many companies within our women's health moonshot, but we are working diligently to bring in more startups focused on women's health, which is such a major step in the right direction, but there just aren't enough out there.
• 16:40
  The few we do have, however, are game changers. So I let Missy give her thoughts on that. Well, you know, I got here s- by being the original grumpy patient.
• 16:49
  You know, I just hit this when I had a baby, and I was not happy, and I was not okay. Absolutely.
• 16:54
  And I, I made a one fortunate call, got to the world-class best doctor in Chicago, and then got the gold standard, you know, a PT, an e-stim, a pessary. I did, like, all these cool things.
• 17:04
  And then I would go back to my mommy friends or my mom's friends, and I'd be like, "Hey, do you have this?" And they'd be like, "Yeah." I'm like, "Well, do you know there's a PT?" "No." "Do you know there's a..." "No."
• 17:13
  Mm. No one knows. And, and we're... You know, my group is pretty well-educated, upper middle class people. And then I started drilling into the, you know, with my doctor, who then became the head of my board.
• 17:22
  I'm like, "Where's the research on Black women? Where's the research on His- Right... on Hispanic Latina women?" You know, meh. Nonexistent. You know, right. Yeah.
• 17:30
  So we did a focus group just to learn vocabulary that they were using. They, they had no idea what I was talking about unless I got to UTIs.
• 17:36
  But, you know, I've been doing this, like, 17 years April Fool's Day, and, you know, it, it is so critically important.
• 17:44
  It's, it's important that we develop these platforms and these products and these companies that get the conversation moving, that help connect women to things that actually can help them.
• 17:55
  That's what I'm excited about with Sisi, is like it's one thing to have a chat room and we all get together and we all talk about how miserable it is, but w- I wanna actually help them.
• 18:05
  And that's what the women, when we did our early focus groups, they were like, "We want action Jackson. We don't want a support group with education.
• 18:10
  We want something that helps."I love how your interview with Missy Lavender really dovetails with, um, my conversation with Dorothy and just, uh, just how many, uh, things that they've experienced build on one another.
• 18:25
  So I wanna talk takeaways, kind of what we've learned from these two conversations. You know, big one for me is this idea of long-term commitment.
• 18:35
  You know, women are seeing more representation in health than they did 30 years ago. I think of companies like Geneve really tackling menopause. Um, but it's been a long, slow road, Dorothy Goldman tells us.
• 18:49
  You know, it's required grit, it's re- required determination and commitment, and this ground wasn't easily won. It needs to be defended.
• 18:57
  So I'm just struck by the need for long-term commitment within the women's health moonshot. Absolutely. I agree.
• 19:04
  And for me, I think that there needs to be not only a better commitment to serving women, but serving women who live in low and middle income countries, and women who simply just don't have that access to solutions like these.
• 19:17
  And chatbot technology like Renalis has that potential to make specialty care for women scalable and affordable, and that's absolutely crucial in opening up access to care everywhere.
• 19:27
  In both of these cases, I'm also just amazed that we're still dealing with silly taboos in health. I mean, for, uh, Renalis, you know, Missy talked about under the belt health, uh, below the belt health.
• 19:40
  It's just health. You know, bladder issues like incontinence can stop you in your tracks. It affects so many people. It's, it's so debilitating. You know, and if we can't talk about it, we can't treat it, and it's 2021.
• 19:53
  I think it's, that's just crazy that those, uh, taboos still exist. We need to be able to talk about what's going on. I 100% agree. You know, women, we're strong.
• 20:02
  We can handle everything men can, despite what others may think. But there comes a point where we're like, "Okay, I don't wanna go through pain if I don't have to. Why can't I find a solution for me?"
• 20:12
  And that's what needs to be addressed, and I'm so glad to be a part of StartUp Health, which is helping to address this exact situation. Awesome. Well, awesome interview with Missy Lavender.
• 20:22
  I loved hearing from both of these voices from the StartUp Health portfolio. [outro music] Well, that's all the time we have today. Thanks for joining me in the virtual studio, India. Absolutely.
• 20:31
  Thanks for having me, Logan. We'll be back next week with more inspiring stories of health moonshot progress. Make sure you follow StartUp Health NOW wherever you get your podcasts. Until next time. See you soon.
• 20:44
  [outro music] Thanks for listening to StartUp Health NOW. StartUp Health invests in health transformers from around the world who are committed to achieving audacious health moonshots.
• 20:57
  If you wanna learn how you can join this community of entrepreneurs, or if you wanna connect with one of our 350 companies, go to startuphealth.com.
• 21:04
  If you'd like to learn how you can invest in our Health Moonshot Rolling Fund in collaboration with AngelList, go to healthmoonshots.com. Thanks for listening to StartUp Health NOW. We'll be back next week. [outro music]